Erectile Dysfunction

Erectile dysfunction is a challenging and embarrassing problem for men.

Defined by an inability to develop and maintain an erection firm enough for sexual relations, erectile dysfunction (ED) affects approximately one in four men during their lifetime. According to research scientists, up to 75 percent of ED cases occur due to medical causes.

• When functioning normally, neurotransmitters initiate an erection by relaying signals from the brain to the vascular system.
• The resulting increased blood flow and pressure to the penis allows tube and elastic like tissue within the penis to expand, achieving erection.

Cause

Many factors contribute to erectile dysfunction, including:

• Blood flow reduction to the penis
• Scarring of the penile tissues does not allow for a normal erection- Peyronie's disease
• Nerve damage (may occur directly to the penis or to areas leading to it)
• Hormonal or metabolic disorders such as diabetes
• Psychological conditions (mainly seen with ED in males under the age of 40)
• Vein leakage, also known as a venous leak
• Trauma, injury, or surgical procedures to the spinal cord or pelvic area
• Vascular disorders or disease such as high blood pressure

• Neurologic related conditions such as multiple sclerosis or Parkinson's disease
• High levels of cholesterol
• Heart disease
• Occurrence and/or treatment for enlarged prostate or prostate cancer
• Obesity
• Sleep-related disorders
• Tobacco use
• Diseases such as alcoholism and other substance abuse disorders
• Psychological related issues

Furthermore, certain medications can lead to erectile dysfunction including antiandrogens (testosterone blockers) used in conjunction with prostate cancer therapy, certain antidepressants, blood pressure medications, sedatives or tranquilizers, some ulcer medications, and appetite suppressants.

Symptoms

Feelings of inadequacy or failure may complicate ED symptoms. ED may result in an inability to maintain an erection sometimes, but not every time. Other signs are the ability to get an erection but unable to maintain it to complete sexual relations, or an inability to attain an erection at all.

Diagnosis

A physician typically asks a series of questions to determine family and sexual history, the male's ability and frequency of erections and sexual relations, levels of satisfaction, any diminished desire for sex, surgeries or injuries near the penis, prescription medication use, and history of using tobacco, alcohol, or illegal drugs.

Checking the penis for sensitivity determines any nervous system origins. Inspection of penile appearance helps rule out Peyronie's disease. A blood pressure check rules out circulation problems by checking wrist and ankle pulse.

A series of blood tests helps determine many medical conditions known to cause ED. A urinalysis indicates any positive signs of kidney problems, testosterone levels or diabetes. Using a nocturnal penile tumescence (NPT) procedure is common. Ultrasound testing and injections may be useful when diagnosing erectile dysfunction.

Treatment

Treatment options vary widely according to the specific diagnosis. Regardless, common treatment includes referral for counseling or therapy due to residual effects ED has to strip the man of confidence and self-esteem.

Medication therapy is effective, especially in older men. Additional treatment may include self-injected medication, vacuum erection devices, or urethral suppositories. Surgical interventions include vascular reconstruction for improved penile blood flow. Penile implants are considered for some cases.